What is the treatment for blepharitis?

From the Guidelines

Blepharitis treatment should start with warm compresses applied to closed eyelids for 5-10 minutes twice daily to loosen debris and oil, followed by gentle eyelid scrubbing using diluted baby shampoo or commercial eyelid cleansers, as this approach has been shown to significantly improve symptoms 1.

Treatment Approach

The treatment of blepharitis involves a combination of eyelid hygiene and medications.

• Warm compresses should be applied to closed eyelids for 5-10 minutes twice daily to loosen debris and oil.
• Gentle eyelid scrubbing using diluted baby shampoo or commercial eyelid cleansers like OCuSOFT or SteriLid on a clean washcloth or cotton swab should be performed.
• For moderate to severe cases, topical antibiotics such as erythromycin or bacitracin ointment may be applied to the eyelid margins at bedtime for 1-2 weeks.
• Oral antibiotics like doxycycline (100mg once or twice daily) or azithromycin may be prescribed for more severe cases, particularly those with rosacea.
• Artificial tears can help with associated dry eye symptoms.
• Anti-inflammatory medications like topical corticosteroids might be used briefly for significant inflammation.
• For seborrheic blepharitis, anti-dandruff shampoo for the scalp and eyebrows can help.
• Omega-3 fatty acid supplements may improve meibomian gland function.

Ongoing Maintenance

Blepharitis is often chronic, requiring ongoing maintenance therapy with eyelid hygiene to prevent recurrence, as it results from bacterial overgrowth and dysfunction of the oil-producing meibomian glands 1.

• Patients should understand that successful management depends on their compliance with a treatment regimen.
• In-office procedures targeting the meibomian glands have shown efficacy in some studies, but there is a lack of independent, randomized controlled studies demonstrating superiority of any one of these treatments over another 1.

Considerations

• The possibility of carcinoma or immune-mediated diseases should be considered in patients with blepharitis who do not respond to therapy, particularly if the blepharitis is associated with loss of eyelashes and/or conjunctival cicatricial changes 1.
• Early diagnosis and appropriate treatment can prevent vision loss and disfigurement, and it may be lifesaving.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION: The ointment should be applied directly into the conjunctival sac 1 to 3 times daily. In blepharitis all scales and crusts should be carefully removed and the ointment then spread uniformly over the lid margins. The treatment for blepharitis involves applying bacitracin ointment directly into the conjunctival sac 1 to 3 times daily, and removing all scales and crusts from the lid margins before applying the ointment uniformly over the lid margins 2.

• Key steps in treatment:
  • Apply ointment 1 to 3 times daily
  • Remove scales and crusts from lid margins
  • Apply ointment uniformly over lid margins

From the Research

Treatment Options for Blepharitis

The treatment for blepharitis varies depending on the cause, location, and severity of the disease. Some of the treatment options include:

• Eyelid hygiene with warm compresses, eyelid scrubs, baby shampoo, and over-the-counter eyelid cleansers 3
• Topical antibiotics and antibiotic-steroid combination drops/ointments for the eye and eyelid 3, 4, 5
• Heat therapy/thermal pulsation treatment to clear obstruction in the meibomian glands and restore meibum secretions 3
• Systemic antibiotics may be appropriate in some patients 4
• Topical corticosteroid preparations may be helpful in patients with marked inflammation 4, 5

Management of Blepharitis

The mainstay of treatment for blepharitis is an eyelid hygiene regimen, which needs to be continued long term 4, 6. This includes:

• Daily eyelid cleansing routines 5
• Removal of scale and debris from the eyelids and eyebrows 6
• Good handwashing habits to prevent cross-contamination 6
• Proper use of cosmetics and contact lens care to prevent infection 6

Specific Treatments for Childhood Blepharokeratitis

In children, oral erythromycin may be a reasonable alternative to tetracycline for the treatment of blepharokeratitis 7. This is because tetracycline and its analogues are contraindicated in children aged less than 8 years due to the risk of dental enamel abnormalities.